|
QUOTE REQUEST - Contact Information |
| Organization Name: |
(if any) |
| |
|
|
First Name: |
|
|
Last Name: |
|
|
Address: |
|
|
City: |
|
|
State: |
|
|
Phone: |
|
|
Zip Code: |
|
|
E-mail: |
|
|
Confirm E-mail: |
|
| Website: |
|
| |
|
| *** |
Do you currently have insurance (if
yes, with which carrier)?
|
| |
|
| |
Current Premium:
(this helps us compare rates)
|
| |
|
| |
|
| |
|
| What styles of Dance do you
teach? |
|
| Year Business
Started: |
|
| |
|
| Do you have a waiver with
wording that has been reviewed by an attorney in your state that is
signed by the parents/guardians for each student? |
|
| |
|
| Claims: |
|
| |
|
| |
|
| |
|
|
COVERAGE OPTIONS |
| General
Liability: |
|
| |
|
|
Professional Liability: |
This coverage is
quoted automatically when available. Please review your quote when
you receive it. |
| |
|
| |
|
| Business
Personal Property
(optional): |
$
Enter the amount of equipment coverage that
you would like here, or you can write "none" |
| |
|
| Do you have any other information
about your business, or comments that you would like to
share? Please place special requests here. |
|
| |
|
| |
|
| |
|
|
|
| |
|
Someone will contact you about your insurance request to go over the
coverage and options usually in the same day. |
|
NO COVERAGE IS BOUND,
OFFERED, ISSUED THROUGH THIS ELECTRONIC COMMUNICATION, ALL POLICIES MUST BE
UNDERWRITTEN AND APPROVED BY THE CARRIER. DO NOT CANCEL YOUR CURRENT
INSURANCE.
Dance School Insurance,
Ballet School Insurance, Fine Arts School Insurance. Vocational School, Trade
School, Specialty School, Training School Tutor, Educator, School
Insurance
Copyright 2011 Stratum
Insurance Agency, LLC
    
|